Frontline care workers started receiving the first doses of Pfizer's and BioNTech's newly authorized Covid-19 vaccine on Monday, Dec. 14, and Moderna's newly authorized vaccine on Monday, Dec. 21. But vaccine development and approval might actually be the easier steps compared to what's to come.
Radio Advisory episode: Your role in vaccine distribution (and why it's harder than you think)
As we dug into the details, we realized that the imperatives for successful vaccine administration are a lot like the imperatives of best-in-class population health management. Yes, there are the logistical hurdles of managing limited vaccine supply or complex storage requirements. But leaders will also need to stratify the risk of their community, engage patients amidst rampant disinformation, coordinate care across multiple locations, and use every tool in their toolkit to close care gaps. These are classic population health imperatives. And while the health care industry has mastered the clinical innovation and scientific discovery that led us to viable Covid-19 vaccines—most providers haven't scaled the basic population health principles that will be necessary to ensuring the vaccine reaches the arms of everyday Americans.
Below are the four population health imperatives for effective vaccine dissemination.
4 population health imperatives for immunizing America
1. Be overly detailed in stratifying risk and prioritizing who gets the vaccine first
CDC has provided initial guidance to help states prioritize who should receive the vaccine first. Given the limited doses available in early shipments, clinical leaders will still need to develop a local risk stratification framework. For example, there may not be enough doses for the highest-priority groups (identified by CDC as health care workers and people in nursing homes) in your community. Like any risk stratification—it's important to remember that this represents huge groups of people. A detailed framework outlining how to prioritize within these categories will reduce confusion and ensure all local populations are accounted for (such as: minority groups and people living in rural areas).
The truth is: you can tie yourself into knots in the details here. There are undoubtedly ethical considerations for who gets the vaccine and when. But our point is that, to date, leaders are far too passive about vaccine distribution and prioritization. If Covid-19 has taught us anything, it's to plan for your worst-case scenario. So, at a minimum, prepare to have fewer doses than expected. And if more arrive, then you already know which populations are eligible next.
2. Commit to outreach and education for all patients, especially the skeptics
Forty-two percent of Americans say they will not take the Covid-19 vaccine once it becomes available. One reason for this is rampant mis- or disinformation. In many ways, the approach to overcoming this is the usual patient education playbook—just on a massive scale. Use every avenue at your disposal (go on local news stations, use social media campaigns and community partners, publicize when your CEO takes the vaccine, etc.). And ensure your message is fact-checked, consistent, and transparent, especially about potential side effects.
The good news is that patients still tend to trust their care team, particularly their PCP. Like with any population health initiative, leaders should arm every clinician and frontline staff member with talking points and the time to discuss the vaccine (regardless of the actual reason for the visit). Tried-and-true patient engagement tactics still apply here: assess patient activation, use motivational interviewing and shared decision-making, and provide translation services whenever they're needed.
But misinformation isn't the only problem here. Leaders will also have to battle the very reasonable distrust that marginalized communities (such as Black communities) have in the medical community. This legitimate distrust of a medical system that has so often failed them is perhaps the biggest threat to equitable vaccine uptake. Addressing these cultural nuances requires a more creative, community-centered approach. For example, consider deploying staff of the same ethnic background as the community in everyday places to discuss the vaccine in the patients' preferred language. Denver Public Health has taken the long view, setting up flu shot clinics in underserved communities to provide education and build trust.
3. Prepare for the most complex care coordination you've ever had to do
Even as CDC stands up a national tracking database, problems remain around data visibility and coordination. If access to up-to-date partner data is limited, there will be an increased risk that sudden supply or capacity shortages arise. And now that two vaccines have reached emergency authorization, both with two doses at differing timelines, the care management challenge is about to get a lot harder.
This challenge is reminiscent of care gap closures, a difficult and longstanding population health priority to improve quality of care—but with added complexity. For example, patients may not return to the same provider for their second dose. So, not only do provider organizations have to conduct typical outreach to patients and offer them multiple accessible options on two separate occasions, they also have to track and coordinate across multiple vaccine administrators for both vaccinations. And, they have to do that even if the patient shows up in a different health care system or even a different state for their second dose. The complexities here are impossible for any single organization to tackle alone. Leaders will have to look to partners—and even competitors—to ensure that patients return for their second dose.
4. Find your community partners and position yourself to support other (even competing) institutions
Community partners are essential to scaling any population health effort. Of course, leaders will have to collaborate to build the right stratification and prioritization list, to provide culturally competent education and resources, and to coordinate care even without a single source of truth. But now is also time to be a partner in your community. For example:
- Lend clinicians or clinical expertise to communities that may distrust the vaccine or are far from large facilities;
- Supply fact-based communication materials (talking points, written materials, etc.) for their staff to use;
- Offer extra doses of the vaccine to smaller organizations; and
- Be open to sharing data and building interoperable tracking systems.
Every health care organization—whether they are a traditional health system, a physician group, even a "disruptor" like CVS Health or Walgreens—is going to have to work together in rolling out this vaccine.
Covid-19 has elevated organizations' population health strategy in many ways—but the arrival of Covid-19 vaccines is perhaps the biggest impetus for leaders to double down on population health. Throughout 2020, organizations with strong population health management competencies better managed the outbreak than those without. We expect the same to hold true for vaccine distribution. Both rely on data-driven risk stratification, robust patient education, consistent care coordination, and trusted community partnerships.